Prediction Score for 24-Hour Mortality in Patients of Septic Shock After Emergency Department Admission at Phra Nakhon Si Ayutthaya Hospital
Keywords:
septic shock, prognosis, mortality, riskAbstract
Objective: The study aimed to develop a prediction score for 24-hour mortality in patients with septic shock. Methods: This prognostic prediction research uses a retrospective cohort design, reviewing medical records from 2018-2022. The study includes patients over 18 years old diagnosed with septic shock (ICD-10 code R57.2) who were treated in the ED and initially suspected of having sepsis from an infection in any part of the body. The study analyzed both patient-related and management-related factors. A comparison was made between patients who died within 24 hours and those who survived beyond 24 hours. Statistically significant factors were identified and analyzed using stepwise Cox proportional hazards regression. These factors were used to create individual items and total scores. The discriminative ability of the model was tested with the c-statistic. The scores were categorized into low, moderate, and high risk groups. Results: Totaling 602 patients, mostly male (52.8%), averaged age 63.5±16.8 years. Among 155 factors was studied, 57 showed statistically significant differences. After further analysis, 16 factors with sufficient population size were identified, and 10 factors were found to predict mortality reliably. The final prediction score ranged from 0.0 to 37.5, with a C-statistic of 0.8086. Based on the score, patients were categorized as low risk (0.0–27.5), moderate risk (28.0–31.0), and high risk (31.5–37.5). The 24-hour mortality rates for these groups were 15.1%, 44.0%, and 91.7%, respectively. Conclusion: This prediction score can be used to categorize patients based on the severity of their risk of death. It can help guide clinical decision-making, particularly in discussions with families about end-of-life care or in directing emergency physicians to provide more intensive management, such as admission to the ICU, for moderate to high risk cases.
References
Bauer M, Gerlach H, Vogelmann T, Preissing F, Stiefel J, Adam D. Mortality in sepsis and septic shock in Europe, North America and Australia between 2009 and 2019- results from a systematic review and meta-analysis. Crit Care 2020;24(1):239.
Gavelli F, Castello LM, Avanzi GC. Management of sepsis and septic shock in the emergency department. Intern Emerg Med 2021;16(6):1649-61.
กลุ่มงานสารสนเทศและคอมพิวเตอร์ โรงพยาบาลพระนครศรีอยุธยา. ข้อมูลผู้ป่วย 2561-2565. พระนครศรีอยุธยา: โรงพยาบาลพระนครศรีอยุธยา; 2566.
Kuttab HI, Lykins JD, Hughes MD, Wroblewski K, Keast EP, Kukoyi O, et al. Evaluation and predictors of fluid resuscitation in patients with severe sepsis and septic shock. Crit Care Med 2019;47(11):1582-90.
Keijzers G, Macdonald SP, Udy AA, Arendts G, Bailey M, Bellomo R, et al. The Australasian resuscitation in sepsis evaluation: fluids or vasopressors in emergency department sepsis (ARISE FLUIDS), a multi-centre observational study describing current practice in Australia and New Zealand. Emerg Med Australas 2020;32(4):586-98.
Liu Z, Meng Z, Li Y, Zhao J, Wu S, Gou S, et al. Prognostic accuracy of the serum lactate level, the SOFA score and the qSOFA score for mortality among adults with sepsis. Scand J Trauma Resusc Emerg Med 2019;27(1):51.
Hwang TS, Park HW, Park HY, Park YS. Prognostic value of severity score change for septic shock in the emergency room. Diagnostics (Basel) 2020;10(10):743.
Long B, Koyfman A, Modisett KL, Woods CJ. Practical considerations in sepsis resuscitation. J Emerg Med 2017;52(4):472-83.
Lee EP, Yen CW, Hsieh MS, Lin JJ, Chan OW, Su YT, et al. Diastolic blood pressure impact on pediatric refractory septic shock outcomes. Pediatr Neonatol 2024;65(3):222-8.
Feng Q, Ai M, Huang L, Peng Q, Ai Y, Zhang L. Relationship between cerebral hemodynamics, tissue oxygen saturation, and delirium in patients with septic shock: a pilot observational cohort study. Front Med (Lausanne) 2021;8:641104.
Suetrong B, Walley KR. Lactic acidosis in sepsis: it's not all anaerobic: implications for diagnosis and management. Chest 2016;149(1):252-61.
Martin MD, Badovinac VP, Griffith TS. CD4 T cell responses and the sepsis-induced immunoparalysis state. Front Immunol 2020;11:1364.
Jensen IJ, Sjaastad FV, Griffith TS, Badovinac VP. Sepsis-induced T cell immunoparalysis: the ins and outs of impaired T cell immunity. J Immunol 2018;200(5):1543-53.
Nan W, Huang Q, Wan J, Peng Z. Association of serum phosphate and changes in serum phosphate with 28-day mortality in septic shock from MIMIC-IV database. Sci Rep 2023;13(1):21869.
Al Harbi SA, Al-Dorzi HM, Al Meshari AM, Tamim H, Abdukahil SAI, Sadat M, et al. Association between phosphate disturbances and mortality among critically ill patients with sepsis or septic shock. BMC Pharmacol Toxicol 2021;22(1):30.
Seo MH, Choa M, You JS, Lee HS, Hong JH, Park YS, et al. Hypoalbuminemia, low base excess values, and tachypnea predict 28-day mortality in severe sepsis and septic shock patients in the emergency department. Yonsei Med J 2016;57(6):1361-9.
Schupp T, Weidner K, Rusnak J, Jawhar S, Forner J, Dulatahu F, et al. Diagnostic and prognostic significance of the prothrombin time/international normalized ratio in sepsis and septic shock. Clin Appl Thromb Hemost 2022;28:10760296221137893.
Iba T, Umemura Y, Wada H, Levy JH. Roles of coagulation abnormalities and microthrombosis in sepsis: pathophysiology, diagnosis, and treatment. Arch Med Res 2021;52(8):788-97.
Moore S, Weiss B, Pascual JL, Kaplan LJ. Management of acute respiratory failure in the patient with sepsis or septic shock. Surg Infect (Larchmt) 2018;19(2):191-201.
Yang T, Shen Y, Park JG, Schulte PJ, Hanson AC, Herasevich V, et al. Outcome after intubation for septic shock with respiratory distress and hemodynamic compromise: an observational study. BMC Anesthesiol 2021;21(1):253.
Ruslan MA, Baharuddin KA, Noor NM, Yazid MB, Noh AYM, Rahman A. Norepinephrine in septic shock: a systematic review and meta-analysis. West J Emerg Med 2021;22(2):196-203.
Hamzaoui O, Scheeren TWL, Teboul JL. Norepinephrine in septic shock: when and how much? Curr Opin Crit Care 2017;23(4):342-7.
Monnet X, Lai C, Ospina-Tascon G, De Backer D. Evidence for a personalized early start of norepinephrine in septic shock. Crit Care 2023;27(1):322.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 สมาคมเวชศาสตร์ป้องกันแห่งประเทศไทย
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
บทความที่ลงพิมพ์ในวารสารเวชศาสตร์ป้องกันแห่งประเทศไทย ถือเป็นผลงานวิชาการ งานวิจัย วิเคราะห์ วิจารณ์ เป็นความเห็นส่วนตัวของผู้นิพนธ์ กองบรรณาธิการไม่จำเป็นต้องเห็นด้วยเสมอไปและผู้นิพนธ์จะต้องรับผิดชอบต่อบทความของตนเอง
